Influenza Vaccinations Among Privately and Publicly Insured Children With Asthma

Annual influenza vaccination rates for children remain well below the Healthy People 2030 target of 70%. We aimed to compare influenza vaccination rates for children with asthma by insurance type and to identify associated factors. This cross-sectional study examined influenza vaccination rates for children with asthma by insurance type, age, year, and disease status using the Massachusetts All Payer Claims Database (2014–2018). We used multivariable logistic regression to estimate the probability of vaccination accounting for child and insurance characteristics. The sample included 317,596 child-year observations for children with asthma in 2015–18. Fewer than half of children with asthma received influenza vaccinations; 51.3% among privately insured and 45.1% among Medicaid insured. Risk modeling reduced, but did not eliminate, this gap; privately insured children were 3.7 percentage points (pp) more likely to receive an influenza vaccination than Medicaid-insured children (95% confidence interval [CI]: 2.9–4.5pp). Risk modeling also found persistent asthma was associated with more vaccinations (6.7pp higher; 95% CI: 6.2–7.2pp), as was younger age. The regression-adjusted probability of influenza vaccination in a non-office setting was 3.2pp higher in 2018 than 2015 (95% CI: 2.2–4.2pp), and significantly lower for children with Medicaid. Despite clear recommendations for annual influenza vaccinations for children with asthma, low rates persist, particularly for children with Medicaid. Offering vaccines in non-office settings such as retail pharmacies may reduce barriers, but we did not observe increased vaccination rates in the first years after this policy change.